Association of High‐Deductible Health Plans With Health Care Use and Costs for Patients With Cardiovascular Disease

Abstract

Background By increasing cost sharing, high‐deductible health plans (HDHPs) aim to reduce low‐value health care use. The association of HDHPs with health care use and costs in patients with chronic cardiovascular disease is unknown. Methods and Results This longitudinal cohort study analyzed 57 690 privately insured patients, aged 18 to 64 years, from a large commercial claims database with chronic cardiovascular disease from 2011 to 2019. Health care entities in which all or most beneficiaries switched from being in a traditional plan to an HDHP were identified. A difference‐in‐differences design was used to account for differences between individuals who remained in traditional plans and those who switched to HDHPs and to assess changes in health care use and costs. Among the 934 individuals in the HDHP group and the 56 756 in the traditional plan group, switching to an HDHP was not associated with statistically significant changes in annual outpatient visits, hospitalizations, or emergency department visits (−8.3% [95% CI, −16.8 to 1.1], −28.5% [95% CI, −62.1 to 34.6], and 11.2% [95% CI, −20.9 to 56.5], respectively). Switching to an HDHP was associated with an increase of $921 (95% CI, $743–$1099) in out‐of‐pocket costs but no statistically significant difference in total health care costs. Conclusions Among commercially insured patients with chronic cardiovascular disease, switching to an HDHP was not associated with a change in health care use but was associated with an increase in out‐of‐pocket costs. Although health care use by individuals with chronic cardiovascular disease may not be sensitive to higher cost sharing associated with HDHP enrollment, there may be a significant increase in patients' financial burden.

Keywords

• cardiovascular disease
• cost sharing
• high‐deductible health plans
• out‐of‐pocket costs
• value‐based care